Implantable cardiac device and method of treating atrial fibrillation

Abstract

An apparatus and method of treating atrial fibrillation (AF) are provided. The apparatus includes means for detecting AF in a heart of a patient, means for classifying the AF as one of a plurality of AF types, means for selecting a therapy for delivery to the heart, from a plurality of therapies, based on AF type, and means for delivering the selected therapy to the heart. The plurality of therapies includes ATP therapy, a hybrid therapy including a combination of ATP therapy and drug therapy, and shock therapy. The method includes sensing an electrogram signal from the heart, analyzing the electrogram signal to detect AF in the heart, classifying the AF as one of a plurality of AF types, selecting a therapy for delivery to the heart, from a plurality of therapies, based on the AF type, and delivering the selected therapy to the heart.

1. A method of treating atrial fibrillation comprising:
 (a) sensing activity of a heart; 
 (b) analyzing the activity to detect atrial fibrillation in the heart; 
 (c) classifying the atrial fibrillation as one of a plurality of atrial fibrillation types including: 
 Type I, wherein Type I comprises discrete organized atrial EGMs with intervening isoelectric lines free of perturbation; 
 Type II, wherein Type II comprises discrete organized atrial EGMs without clear isoelectric intervals; 
 Type III, wherein Type III comprises disorganized atrial EGMs without clear isoelectric intervals; and 
 Type IV, wherein Type IV is characterized as alternations between Type I and Type III; 
 (d) selecting a therapy from a plurality of therapies, wherein the therapy for Type I and Type II atrial fibrillation is ATP therapy, and the therapy for Type III and Type IV atrial fibrillation is a hybrid therapy, wherein the hybrid therapy is a combination of ATP therapy and drug therapy; and 
 (e) delivering the selected therapy to the heart. 
 
   
   
     2. The method of  claim 1 , wherein when drug therapy is selected in step (d), step (e) comprises delivering a drug to the heart, the drug being selected from a group consisting of: class I drugs, class III drugs, and dofetilide. 
   
   
     3. The method of  claim 1 , further comprising:
 (f) determining if the selected therapy was successful in terminating the atrial fibrillation; and 
 (g) delivering a more aggressive therapy to the heart than in step (e) if the selected therapy was unsuccessful. 
 
   
   
     4. The method of  claim 3 , wherein when step (e) comprises delivering a hybrid therapy to the heart, step (g) comprises delivering shock therapy to the heart. 
   
   
     5. The method of  claim 3 , wherein when step (e) comprises delivering ATP therapy to the heart, step (g) comprises delivering shock therapy to the heart. 
   
   
     6. An implantable cardiac device comprising:
 means for detecting atrial fibrillation; 
 means for classifying the atrial fibrillation as one of a plurality of atrial fibrillation including: 
 Type I, wherein Type I comprises discrete organized atrial EGMs with intervening isoelectric lines free of perturbation; 
 Type II, wherein Type II comprises discrete organized atrial EGMs without clear isoelectric intervals; 
 Type III, wherein Type III comprises disorganized atrial EGMs without clear isoelectric intervals; and 
 Type IV, wherein Type IV is characterized as alternations between Type I and Type III; 
 means for selecting a therapy from a plurality of therapies, wherein the therapy for Type I and Type II atrial fibrillation is ATP therapy, and the therapy for Type III and Type IV atrial fibrillation is a hybrid therapy, wherein the hybrid therapy is a combination of ATP therapy and drug therapy; and 
 means for delivering the selected therapy to the heart. 
 
   
   
     7. The implantable cardiac device of  claim 6 , further comprising:
 means for determining if the selected therapy successfully terminated the atrial fibrillation; 
 means for selecting a more aggressive therapy if the selected therapy was not successful in terminating the atrial fibrillation; and 
 means for delivering the more aggressive therapy to the heart. 
 
   
   
     8. The implantable cardiac device of  claim 7 , wherein when the selected therapy is ATP therapy, the more aggressive therapy is the hybrid therapy. 
   
   
     9. The implantable cardiac device of  claim 7 , wherein when the selected therapy is a hybrid therapy, the more aggressive therapy is shock therapy. 
   
   
     10. The implantable cardiac device of  claim 7 , wherein when the selected therapy is ATP therapy, the more aggressive therapy is shock therapy. 
   
   
     11. The implantable cardiac device of  claim 6 , further comprising means for notifying the patient of the need to receive administration of a drug, wherein the drug is selected from a group consisting of: class I drugs, class III drugs, and dofetilide. 
   
   
     12. An implantable cardiac device comprising:
 a sense circuit to sense activity of a heart; 
 a processor coupled to the sense circuit to analyze the activity and detect atrial fibrillation of the heart, classify the atrial fibrillation by type, including: 
 Type I, wherein Type I comprises discrete organized atrial EGMs with intervening isoelectric lines free of perturbation; 
 Type II, wherein Type II comprises discrete organized atrial EGMs without clear isoelectric intervals; 
 Type III, wherein Type III comprises disorganized atrial EGMs without clear isoelectric intervals; or 
 Type IV, wherein Type IV is characterized as alternations between Type I and Type III; and select a therapy based on the designated type; and 
 a therapy circuit, responsive to the processor, to deliver the selected therapy to the heart. 
 
   
   
     13. The implantable cardiac device of  claim 12 , wherein the selected therapy is selected from a group consisting of: ATP therapy, a hybrid therapy, and shock therapy. 
   
   
     14. The implantable cardiac device of  claim 12 , wherein the processor is configured to determine if the selected therapy successfully terminated the atrial fibrillation and the therapy circuit is configured to switch to a more aggressive therapy if the selected therapy was not successful in terminating atrial fibrillation in the heart. 
   
   
     15. A method of treating atrial fibrillation comprising:
 sensing activity of a heart; 
 analyzing the activity; 
 detecting atrial fibrillation of the heart; 
 classifying the atrial fibrillation by type, including: 
 Type I, wherein Type I comprises discrete organized atrial EGMs with intervening isoelectric lines free of perturbation; 
 Type II, wherein Type II comprises discrete organized atrial EGMs without clear isoelectric intervals; 
 Type III, wherein Type III comprises disorganized atrial EGMs without clear isoelectric intervals; or 
 Type IV, wherein Type IV is characterized as alternations between Type I and Type III; 
 selecting a therapy based on the designated type; and 
 delivering the selected therapy to the heart.